Hatano Masaki, Kitajima Izuru, Yamamoto Seizo, Nakamura Masaki, Isawa Kazuya, Hirota Yutaka, Suwabe Tatsuya, Hoshino Junichi, Sawa Naoki, Ubara Yoshihumi
Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan.
Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.
Bone Rep. 2021 Apr 6;14:101062. doi: 10.1016/j.bonr.2021.101062. eCollection 2021 Jun.
Currently, the pathogenesis of nontraumatic heterotopic ossification (HO), e.g., bone-like tissue in calcific tendinopathy remains unclear. Here, we report a 75-year-old, right-handed Japanese woman who had been on hemodialysis for 3 years and was admitted to our hospital to evaluate pain and swelling of the right forearm. She worked as a cook, and her main job over the 3 most recent years had been the frequent and continuous shredding of cabbage. A radiograph showed the highly radiopaque material on the dorsal aspect of the right wrist and in the right shoulder. The biopsy of this radiopaque material revealed HO with marrow, as well as calcified material. Histomorphometric analysis of the HO identified a severe type of osteitis fibrosa with a fibrous tissue volume to total volume of 19.8% (>0.5% required for diagnosis) and an osteoid volume to bone volume of 20.0% (>15% required for diagnosis). We found more woven bone-like tissue than lamellar bone-like tissue. However, the intact parathyroid hormone level was 3-times the normal upper limit with 203 pg/mL, but histomorphometric analysis of the right iliac crest revealed normal bone structure. These findings indicate that the frequent and continuous shredding action with the right hand contributed to the nontraumatic HO localized on the dorsal aspect of the right wrist.
目前，非创伤性异位骨化（HO）的发病机制尚不清楚，例如钙化性肌腱炎中的类骨组织。在此，我们报告一名75岁、惯用右手的日本女性，她已接受血液透析3年，因右前臂疼痛和肿胀入住我院。她是一名厨师，在最近3年里，她的主要工作是频繁且持续地切卷心菜。X线片显示右腕背侧和右肩部有高度不透射线的物质。对这种不透射线物质进行活检，发现有含骨髓的异位骨化以及钙化物质。对异位骨化进行组织形态计量学分析，确定为严重类型的纤维性骨炎，纤维组织体积占总体积的19.8%（诊断要求>0.5%），类骨体积占骨体积的20.0%（诊断要求>15%）。我们发现编织状类骨组织比板层状类骨组织更多。然而，完整甲状旁腺激素水平为203 pg/mL，是正常上限的3倍，但对右髂嵴进行组织形态计量学分析显示骨结构正常。这些发现表明，右手频繁且持续的切菜动作导致了局限于右腕背侧的非创伤性异位骨化。
